This approach has the advantage of avoiding antipsychotic side effects altogether. This work is at an early stage and at the time of writing its effectiveness is not known, though initial results are promising.
Nevertheless, it would widen treatment choice for some people and represent a major step forward in treating psychosis. Antipsychotics are effective in treating schizophrenia and mania but can cause a range of side effects. Weight gain is a common and serious side effect, especially due to its impact on physical health.
Various interventions can help and a psychiatrist will be able to offer advice on these. Many people taking antipsychotics can lose some weight with simple changes to their diet and lifestyle. Losing even a small amount of weight can have important health benefits. Ongoing research is attempting to find ways to better manage or ideally avoid this problem. The BAP Guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment are available at: www.
An article reviewing these Guidelines is available at: www. Eur Psychiatry 24 6 BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment.
J Psychopharmacol 30 8 Efficacy and tolerability of olanzapine, quetiapine, and risperidone in the treatment of early psychosis: a randomized, double-blind week comparison. Am J Psychiatry 7 N Engl J Med Last updated: March PLoS One 9 12 : e The STRIDE weight loss and lifestyle intervention for individuals taking antipsychotic medications: a randomized trial.
Am J Psychiatry 1 Diabetes Care 34 7 : — Trials Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. The Lancet , My Sons weight more than doubled in the 5 years that he took Clozapine. He recently passed away and complications of obesity is noted on his death certificate.
So much more work is needed in the control of weight gain in these poor souls who are already suffering enough. I agree with you that more work is needed to manage weight gain associated with antipsychotics. I am a Special Olympic ski coach and one of my dear athletes is extremely overweight from his anti-psychotic drugs. He was recently told he could not stop his meds. I fear for him. I know his lifestyle is unhealthy too and was wondering if we just got him out walking a few times a week would help.
Walking can help to lose weight. If you increase your physical activity you will burn more calories. If you burn off more calories than you consume through food and drink, then you will lose weight. Increased activity can be achieved in many ways, for example walking, using stairs in preference to taking a lift, taking part in sport or exercising at home or in a gym.
The more intense your activity or exercise, and the longer it lasts for, then the more calories that are burnt. Walking is relatively easy to do. Many people find a walk relaxing and if done with others it can be sociable.
Regular walking can have other health benefits including lowering blood pressure and reducing your risk of heart disease. Increased activity is more effective in helping to lose weight if it is combined with changes to diet i. The weight gain from these medications is more detrimental than the illness Bipolar II I personally suffer from initially.
As you highlight both psychiatric illness and the side effects of antipsychotic medication can cause great distress. Good psychiatric care aims to ensure that people receive effective treatment, experience as few side effects as possible and are fully involved in decisions about their care. Shared decision-making by doctors and patients is recommended when choosing treatments. This means that the patient and their doctor discuss the range of treatments available.
The patient brings their experience of their illness, including symptoms they want to be treated and particular side effects they wish to avoid. A joint decision on what treatment to use can then be made. This allows treatment to be tailored to the individual. Patients are usually more satisfied when decisions are made in this way. As antipsychotics vary in their side effects it is usually possible to reduce side effects by choosing medication carefully.
Unfortunately, side effects can still occur. When this happens, the doctor and patient need to carefully consider what to do next. This will depend on how they view the trade-off between the advantages and side effects of the current medication.
It may be that the antipsychotic has had clear benefits, for example in reducing or eliminating symptoms of illness and allowing the person to manage better in their everyday life. They also need to consider how the current medication fares again any earlier medications that were used and medications and treatment approaches that have not yet been tried. If the person is well and contemplating stopping medication totally, then the risk of a recurrence of illness needs to be assessed; this will partly depend on the frequency and severity of any previous episodes of illness.
When all this information is available, the patient and their doctor can consider the options and make a joint decision about what to do next. In some cases, it may be decided that a side effect is worth accepting given the benefits of the medication. In other cases, it may be clear that the side effect is intolerable and that the medication needs to be altered. Many side effects lessen when the dose of an antipsychotic is lowered but weight gain is an exception; the degree of weight gain is usually unrelated to the dose of an antipsychotic.
Some side effects can be reduced by changing the time at which the medication is taken. For example, sedation may be less troublesome when medication is taken at bedtime rather than in the morning. Some side effects can be lessened by taking another medication to deal with them. Sometimes the best option to manage an antipsychotic side effect is to change to a different medication with a lower risk of causing that side effect.
If the person has schizophrenia or psychosis then one will need to switch to a different antipsychotic. If the person has bipolar disorder then it may be possible to switch the antipsychotic to a different type of medication, for example lithium. A person should never stop or reduce the dose of their antipsychotic medication without discussing and agreeing this first with their psychiatrist.
Stopping antipsychotics and reducing their dose are both associated with an increased risk of relapse i. A period of close monitoring by a psychiatrist, or other mental health care professional, is needed whenever an antipsychotic is reduced in dose, switched or stopped. This is to ensure that the person remains well and that support and help are promptly available should there be any problems, including side effects or early warning signs of relapse. Have stopped taking them though due to me refusing my DAM Ng tube and have been in tears for over 24 hours… Not sleeping.
Voices in my head…. Hi Megan I hope you have remedied your problem although sadly I doubt it anti psychotic are terrible. I have bpd my psyche put me on quetiapine massive weight gain then my doctor put every problem I had down to being over weight but that was out of my hands due to the anti psychotic. Take care Megan x. I am struggling on arirprizole, and my mood swings have not got better on it. They tend to be connected to my menstrual cycle. I am hungry all of the time and it makes me tearful.
It is horrible. I want to do my job as an actor and I have lots of additional body fat that gets in my way when I am exercising. A very helpful article. I personally suffer from psychotic depressive episodes, for which I am prescribed a low dose of olanzapine.
When I most recently stopped taking it, after a long period of stability, I became severely delusional about a month later, resulting in a hospital admission. So, I have concluded that I need to be on antipsychotic medication to keep sane. However, 3 months before the admission, I was using ketamine and magic mushrooms.
So the recreational drugs may have had more of an impact than the lack of medication. Anyway, I am keen to lose weight so if anybody can offer advice on going drug free, switching drugs, or simply dieting and hitting the gym, that would be great.
Hay did you know that ketimine is now an anti depressant for when no others work… I was on it for AGES privately until I stopped both eating and drinking.
I have been on Divalproax for 3 yrs. I feel like a vegetable. Lathargic,loss of interest in everything, never happy,extreme weight gain. Memory loss! What can I do? I want to feel normal again.
What started this was my addiction to alcohol. I havent had a drink in 3 yrs. Divalproex is that Epival? Good for staying of drink maybe now ur meds can b reduced c ur doc being tired all the time might mean ur meds r too strong. I have serious weight gain from quetiapine. I went from fit and slim I find the biggest problem is carbohydrates.
Not the weight as a lot of it is muscle as well. I do find that cutting down on food in take works abut but I get very sore stomach that kicks in at about 4 am.
I feel there is direct link between carbohydrates and quetiapine. If I remove the carbohydrates the swelling around my abdomen reduce dramatically but I start to feel down and everything is ok until that happens.
The passive abdomen swelling is the biggest pain as I lose the weight the pain starts and vice versa. I once read that to go on a low carb diet in very bad while on quetiapine as it undermines the effectiveness of the medication. Every time I try to discuss this with my doctors I get the same answer. People in the intervention group lost an average of about 10 pounds over the duration of the study. Those in the comparison group also lost some weight, but much smaller amounts, the authors write.
In the intervention group, 40 percent of participants lost at least five percent of their initial body weight, and 18 percent lost at least 10 percent of their initial weight. Over the course of the year, fasting blood sugar levels went down in the intervention group, but they went up in the comparison group. Use of antipsychotic drugs in the U.
The intervention resulted in a relatively modest weight loss, and did not depend on the type of medication, said Dr. Daniel J. Mueller, who has done research on ways to improve psychiatric drug treatment at the Center for Addiction and Mental Health in Toronto.
A therapy group with people who have gained weight because of their psychotropic medications might, on the other hand, be helpful. It'll be important for providers to take the time to individualize their approach. Losing weight while on psychotropic medications isn't fast or easy. Although it may be difficult, take encouragement from knowing there is solid research to show it is possible to lose weight, and still take your medication.
If you're concerned about weight gain caused by the medication you take, consult with your healthcare provider to develop a plan that will work for you. Dealing with racing thoughts? Always feeling tired? Our guide offers strategies to help you or your loved one live better with bipolar disorder. Sign up for our newsletter and get it free. Antipsychotic-associated weight gain: management strategies and impact on treatment adherence. Neuropsychiatric Disease and Treatment.
Monitoring and managing weight gain in the mentally ill. J Clin Psychiatry. Lifestyle interventions for weight loss among overweight and obese adults with serious mental illness: a systematic review and meta-analysis. General Hospital Psychiatry. Your Privacy Rights. To change or withdraw your consent choices for VerywellMind. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page.
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